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Breastfeeding, Infant, Nutrition, Systematic review, WIC.



  1. Hedberg, Inga C MSN, RN, FNP-BC


Background: Breastfeeding (BF) initiation rates in the United States have increased over the past 11 years by 3.6%. However, women who participate in the Women, Infants, and Children (WIC) program are almost 12% less likely to initiate BF than the general population, and less likely to continue for a year.


Purpose: To identify barriers to BF in order to recommend guidelines for the WIC population.


Study Design and Methods: A systematic review using the search words WIC and BF was conducted using the CINAHL, PubMed, and Cochrane Library databases. Inclusion criteria were articles studying the WIC population alone and/or relative to other populations. Twenty-four articles from the last 5 years were reviewed and graded according to the Evans' hierarchy of evidence.


Results: Barriers to BF in the WIC population were sorted into five categories: lack of support inside/outside the hospital, returning to work, practical issues, WIC-related issues, and social/cultural barriers. Factors predisposing to lower BF rates include non-Hispanic ethnicity, obesity, depression, younger age, or an incomplete high school education. Interventions trialed with positive outcomes include peer counseling, improved communication between hospital lactation consultants and WIC staff, breast-pump programs, and discouraging routine formula provision in the hospital and by WIC.


Clinical Implications: Reasons for low BF rates in the WIC population are complex. More research is needed into interventions tailored for WIC participants. Recommendations for clinicians include initiating peer-counseling programs, prenatal/ postpartum education, in-hospital BF support, and changing the focus of WIC from formula to BF promoting.